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Gold, incentives and meh

RCGP meets with medical school heads to discuss 'toxic anti-GP' culture in universities

The RCGP is meeting with medical school heads to discuss the ‘toxic anti-GP culture’ in universities, which has to be addressed before the gaps in GP postgraduate training can be fixed, RCGP chair Dr Maureen Baker has said.

Responding to a question about low morale in the profession affecting whether medical graduates want to study general practice at a session during the RCGP conference in Liverpool last week, Dr Baker said that she had raised the issue of a ‘toxic anti-GP culture’ medical schools in meetings with officials.

She said that evidence suggests that students go in to medical schools with positive feelings about general practice, but this is gone by the time they leave.

It comes as GP training is in the middle of a recruitment crisis, with Health Education England falling well short of targets for recruiting GP trainees, and some parts of the country failing to fill up to 40% of places for this year’s intake.

Dr Baker’s comments follow statements by the chief executive of NHS England, Simon Stevens, who told the same conference that the rates of Oxford and Cambridge universities graduates taking up general practice was low, and called on GPs to rectify this by helping to ‘make more of the folks you teach at Cambridge more interested in taking it up’.

Similarly, last year the then chair of the GP National Recruitment Office, Professor Bill Irish, told Pulse that top universities in the country are not doing enough to produce future GPs and are adding to a recruitment crisis in the profession, while a taskforce on GP training recommended that medical schools were incentivised to produce GPs.

The RCGP chair said that she the college will be putting together evidence to discuss the issue of the culture in medical schools before meeting with the Medical Schools Council.

Dr Baker said that she had raised the issue of a ‘toxic anti-GP culture’ in meetings with education leaders.

She said: ‘There were quite a lot of colleagues who thought that was an astonishing thing to say and that it must have been years ago and that it was not like that anymore. I said that actually it was still like that and indeed we did have evidence.

‘The head of the Medical Schools Council has formally asked for a meeting to discuss this issue and we will be putting together evidence and looking at the published literature.

‘Evidence suggests that when students go into medical school, they are very positive about general practice, and when they come out of the other end, they are not. So what is going on?’

She added: ‘It will be part of how we move our campaign on, in terms of tackling attitudes to medical school.’

A taskforce review from July this year - led by GP postgraduate deans, having been commissioned by the Department of Health - called for medical schools to review their output of GPs.

It said: ‘The Medical Schools Councils should evaluate why there is such high variation between medical schools in the proportion of medical students choosing General Practice as a career:11% of students at Cambridge were appointed to GP training, compared to 39% at Keele.

‘Medical schools should be incentivised by the Department of Health to boost the proportion of graduates choosing GP training as a first choice.’

Mr Stevens last week said: ‘I was looking at the proportion of medical school graduates who choose to go into general practice and Oxford and Cambridge are amongst the lowest. A bit of a cheap jibe, perhaps, but one thing you could help us with is make more of the folks you teach at Cambridge more interested in taking it up.’

Readers' comments (40)

  • Why don't the RCGP arrange a meeting with Paul Dacre and his editorial colleagues if they truly want to address the source of the 'toxic anti GP culture'.?

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  • ‘Evidence suggests that when students go into medical school, they are very positive about general practice, and when they come out of the other end, they are not. So what is going on?’

    What tosh. What is going on indeed. Maureen puts that down to the fault of the medical school? toxic culture? The current working environment is so bad that it filters down to the students, however you try and dress it up. Still missing the point, which is, make the working environment more attractive, they want to be GPs, not try and teach, maybe even 'lie' to them about it. If they have unrealistic expectations of what it is like in real life, then how do you expect to RETAIN them?

    Can't be sheer incompetence that RCGP are missing the point, can it? or a deliberate attempt to deflect from the real issues? or maybe just doing what they think they can, with no real power or desire to challenge the real life working environment

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  • its completely natural for the young to be drawn to what is seen ( and is to some extent) the glamorous. Its as you get older and wiser you see the benefit of public health and primary care and realize real change happens at a simpler level. The resp and cardiac clinic rooms are for salvage.

    The US has until the last 20 yrs has relatively poorly developed primary care and is prob the reason why outcomes are so poor wrt money spent.

    RCGP should work on retaining those who understand primary care - let medical school do their thing.

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  • I'm really not sure which planet Dr Baker worked as a GP - certainly not planet Earth!

    Last week it was defending NHSE chief who called us "corner shops" followed by great suggestion of getting a PA for GPs. Now blaming med schools?

    Why doesn't she meet with NHSE and DoH and tell them they are the ones creating a toxic culture?

    No? It probably interferes with her political aspirations too much. We really should have a vote of no confidence in her and all of RCGP council

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  • Medical undergraduates are not stupid,they get to see how gps are treated and respected.I also suspect they have been reading the tirade against us from th gutter press and the general reporting agianst us.Last but not least they get to spend some time in practice to see what its like.They see General Practice as it is and make their own minds up.The powers that be including RCGP need to recognise what its like on the coal face and make our working lives less beurocratic and more fulfilling.The establishment cannot buck the market to make more people go into general practice there has to be somthing in it for them.At the moment there is a long list of cons and not enough pros to keep our numbers up on General Practice UK.The future seems bleak,If not in 5 year when the 50 year old leave,it will be even worse in 10 year when the fortysomething are burnt out and start leaving in their droves.Something needs to change for the better and soon.The RCGP are part of the problem .

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  • the solution is simple just follow Stevens and Howe's suggestion and lie to them - tell them life as a GP is fantastic and their future as independent doctors are secure and promise them that their term and conditions will not be torn apart. Tell them that they are valued and the GMC will treat them with respect and yes Santa Claus does exist and there are pixies at the end of the garden. Also tell them not to worry as they will have medical assistants to help them so it will be ok.

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  • Medical students are not stupid.The only thing that is toxic is general practice.Isn't it unethical for the head of the RCGP to encourage future young doctors to make a choice that they will most probably regret?

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  • Agree with all the above.
    There's something comical about them scratching their heads over this.
    Though ultimately this just reinforces for me how out of touch Maureen and the RCGP are with the bulk of us. They do not represent me

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  • Una Coales. Retired NHS GP.

    There has always been a prevailing attitude in medical schools, both in the US or UK, that those who have the brains end up as surgeons and those who fall in the bottom of the class become GPs. Why?

    Hm let's see, if you are smart, you get to become a semiprivate consultant surgeon at a NHS teaching hospital on a 6 figure salary+clinical excellence award top ups + income from a private practice. One London colorectal consultant surgeon boasted to me of his £400k total income. If you are not so smart, you may end up as a NHS salaried GP on £54k working long hours and never be able to afford a house in London for your family as you will be forever trying to repay £100k government student loans for tuitions and maintenance with no scope for private practice.

    No such thing as a 'toxic anti-GP' culture in universities, just simple economics and facts of life.

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  • Not many medical students go into medicine wanting to do General Practice! Most of us (not all) wanted to be a heart or brain surgeon.

    The changes in the contract in 2004 brought pay up and attracted more recruits. But all the negative press does not help one bit

    The way to attract candidates is to make general practice attractive.

    Otherwise I would suggest all medical students to choose hospital based medicine for much higher salaries on 4-6 clinical sessions a week and getting paid for 10!!

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  • I qualified in 2002 and I'm afraid everyone from the statistics lecture (not a doctor may I add) saying "90% of you are going to be GP's so you don't need to know anything" to the professors and consultant never had a single nice thing to say about GP's or being a GP. That has no changed at all as far as I'm aware and in fact is getting worse. The RCGP, BMA and the toothless bodies who represent us have only made it worse and are just as much to blame. It is a crap job, with all the responsibility and no positives at the moment except being your own and setting your own work pattern, this too is unlikely to last. Consultants think they can treat you like their houseman. The resilient GP and fellow like minded GP's fighting back are the only things keeping me going. Not sure how long it will last. RIP General practice. Thanks for nothing RCGP and BMA.

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  • I went to Southampton and not anti GP as I recall. Always the odd jibe from the odd snooty type but a lot of that is banter. 10 years ago when you could earn 120k and have a busy but not ridiculously stressful working day it was attractive to those of us who wanted variety, to connect with patients on more of a personal level and weren't just interested in money. Now with saleries dropping stress workload beurocracy increasing not to mention the constant micro-management, prescribing/referral restrictions etc I think we feel like undervalued overworked technicians with little clinical freedom so how does that stimulate us on an intellectual level? We don't want to be told what to do all the time we want to treat each patient as we see fit, ie, holistically and tailored to them, and I think med students see this constraint, stress and low pay and think where's the positive side?
    If universities are being negative they are right to be, otherwise they would be doing their students a disservice in the current climate.

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  • I will never advise my children to enter general practice so why should i lie to someone else's?
    KEEP AWAY FROM GENERAL PRACTICE

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  • Took Early Retirement

    I am seriously regretting that Clare Gerada couldn't have another term in office.

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  • When I went into general practice, I did so because I wanted to be part of a community and get to know the patients. I wanted to practice holistic medicine and feel that, with my patients, I could make a difference to their lives. I knew that my choice was not sexy and exciting in the way that brain surgery was but felt that the personal relationships with patients, respect and continuity would make up for it.
    Sadly every aspect of the job that I enjoyed has been eroded. Continuity barely exists, we have been reduced to a boring, mechanical, tick box medicine and are forced to think protocol before patient preference. Alongside this the sheer volume of work has created stress and even less time to actually communicate with patients.
    Without the rewarding parts of the job it has become miserable, demoralising, exhausting and sadly boring.
    Why in Gods name would a medical student choose it?

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  • Having finished my GP training a few months ago, I'm so glad that I am now free (and thankfully still young enough) to retrain!
    GP is simply being swarmed - by patients who take no responsibility whatsoever for their health and politicians who demand yet ever more from GPs fuelling unrealistic demands. Things must change...and if that means that my generation of newly qualified GPs either emigrate, change speciality or quit medicine altogether leading to a complete collapse - so be it

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  • I've never understood why these professional hierarchies exist in medicine, if anything GPs have the hardest job. Specialists have an extremely narrow outlook (relating to their one organ or interest), receive patients who have already been nicely filtered and do the same boring repetitive tasks over and over again. At least GPs have variety and have continuity of care to provide a realistic chance of seeing and learning from the outcome of their interventions, whereas secondary care specialists often just treat and discharge, never to see the patient again.

    The sad thing is that instead of finding the holistic approach to medicine attractive, GPs are insisting it's high pay they need to draw them to the job. It makes you wonder if the right candidates are being selected. If you think the job of caring for patients is worthwhile, you'd do it without obsessing about whether your salaries are bigger than consultants.

    Do the job because it's worthwhile, not because it pays for skiing trips and school fees.

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  • Anonymous | Other healthcare professional | 09 October 2014 3:01am

    Please read my post of 0.33....
    I did general practice for all thse reasons. Money is simply not an issue for me....I am lucky enough to have a husband who earns enough to provide the very simple lifestyle that we enjoy.
    The job has become miserable and it is no longer possible to provide the holistic care that you advocate. It is soul destroying to go in day after day and be forced to do mindless tasks which I do not believe help the patient in any way but make it impossible to spend time with them. To then get castigated by people like you who do not understand and label us as greedy and uncaring is the final nail in the coffin.
    (Ex partner with patient satisfaction at 98%)

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  • @0.33 'Miserable demoralising exhausting and boring'- perfectly encapsulates current general practice. At 50 still doing 9 sessions after 20 odd years I am unable to emigrate and am genuinely unsure how long I can continue in this weird, toxic and hostile job.

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  • My advice to med students - don't go into general practice unless you want to emigrate somewhere that GPs are treated well and respected. As for the RCGP - a hopeless waste of time!

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  • 5.13pm-AGREE!

    And PULSE-we must be allowed to comment on The Daily Mail's moral crimes without fear of "moderation" by PULSE.

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  • This comment has been moderated.

  • The tragedy is that GP could still be a fantastic job but the RCGP are making things a lot worse. However you look at it you'd have to be mad to prefer GP at present:

    Workload - increasing to absurd levels
    Responsibility - increasing "see your GP"
    Criticism from the press and government - increasing
    Pay - decreasing at an alarming rate
    Risk of GMC and legal complaints - increasing
    control over working environment - increasing

    General practice is on it's knees. As a medical student you'd have to be mad to sign up for sale to the corporate sector. This is not going to end well.

    PS Brain surgery is actually really boring!

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  • Aren't the likes of the BMA financial products? If there is a failure to support members could this be misselling? In which case could this be potentially a referral to the financial ombudsman or indeed a class action by GPs en mass due to the BMAs failure to represent its members?

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  • Azeem Majeed

    I am the head of the academic primary care department at Imperial College London. I don't feel that the environment in my medical school is 'toxic'. In fact, the environment for academic primary care in my own medical school has probably never been better.

    We are expanding primary care based teaching and research. We are also developing innovative programmes for teaching new skills such as the case management of patients with complex health needs. Students are very positive about their experiences with us and we have recently established an undergraduate GP society – see http://goo.gl/B6ezDu

    If GP recruitment and retention is falling, it's not linked to the environment in medical schools but rather to the pay and working conditions of NHS GPs.

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  • They seem to have serious problems with REFLECTION and finding solutions to the problem they may have contributed to loom.
    For example, they kept on bashing the GP trainees for failing the CSA, an exam which has no transparency. They continue to conduct it behind the closed doors. No real prospect of appealing examiners decisions fairly. Deliberate deprivation of evidence to challenge the outcome of the exam!!
    Now they seem to have picked the fight with the Medical schools to cover up the real reasons why many graduates do not want to get in to GP training.
    I WONDER WHAT MEASURES RCGP HAS TAKEN TO ENCOURAGE MEDICAL STUDENTS OR QUALIFIED DOCTORS TO CHOOSE GENERAL PRACTISE OTHER THAN CONTRIBUTING TO RELEASE HUNDREDS OF DOCTORS AFTER THREE YEARS OF GP TRAINING WHICH WAS FUNDED BY THE TAX PAYERS MONEY???
    ONE SHOULD TAKE CARE OF THE “TOXINS” IN THEIR OWN BACK GARDEN FIRST BEFORE POINTING FINGERS TO OTHERS “TOXINS”!!
    -LWT

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  • This comment has been moderated.

  • I am a GP. I have a 3yr old daughter. I hope, from the fact that she rarely sees me, and if the government have their way, she will see me even less, is enough to persuade her of the folly of entering NHS medicine and particularly, General Practice. I will do my very best to ensure she never enters the remnants of this "profession", and if she does, persaude her to emigrate at the very first opportunity to a country where doctors are valued. I teach medical students about general practice - but it is not my job to persuade them to come into the job. They can see with their own eyes what 20 years of unfettered demand, fed by the cardies of the RCGP, has made of the job.

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  • I have always tried to be fair to the RCGP and tried to see both sides when they have been criticised. sometimes the barbs have been fair and sometimes not but I finding it hard to remember any good news coming out of the RCGP. They are increasingly being seen as out of touch and too cooncerned with appearance. The problem is that this is reality and not a perception.
    They constantly nag us to become Fellows but who would want to be a Fellow of a College that is a laughing stock. There was a time when the other Collegs treated the RCGP with some respect but now they regard it as a joke. Not angry but very sad. And dont say try and change it, then. the same names come up for election and you knwo who will be elected for Council and don't you dare step outside the party line.

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  • Sorry Azeem, I qualified from Imperial College in 2002 (mine is the first comment on page 2) and I am afraid what you say is just not true, unless a lot has changed in these last 12 years. I know people who have qualified in the last few years from Imperial as well and they tell me it is just the same. The attitudes of the lecturers and consultants/professors have to change, and it is not likely in our generation.

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  • Sorry at the big 4 medical schools: oxford, cambridge, UCL and Imperial: no one within the faculty gives much respect to Public Health or Primary Care.

    But having said that the RCGP problems are of its own creation. The CSA has no credibility across a number of areas. The RCGP ignores major issues for ideological reasons and whilst GP pay is so poor why would new graduates with heavy debts bother with it.

    It is a very simple problem, easy to solve. And the fact it isn't being discussed suggests the problems will worsen.

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  • I think the obvious answer is to get more GPs to lecture in medical schools. Primary care was quite well regarded when I was a student because the teachers were pretty good.

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  • I can remember one consultant in hospital referring to GPs as "a joke".

    Perhaps given the sort of package they are on (full service - £400k lump sum, £71k/yr index linked tax payer subsidised pension, merit point pay not linked to performance) might also explain why the consultants who dominate the BMA don't want to rock the boat and don't give a s*** about GPs.

    Who knows. If the GPs can be broken mabe the consultants will be next. The Daily Mail could have a field day.

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  • Vinci Ho

    Sigh!
    To put the cart before the horse.
    To attend to the consequence but neglect the origin.
    I would have thought a scholar could have understood that.......

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  • Teaching medical students is one thing but don't piss on their back and tell them it's raining.

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  • Ivan Benett

    Perhaps we should start talking up General Practice ourselves, rather than listen to the GP bashing that goes on in these columns. How can we expect young doctors to want GP as a career when they hear the sort of drivel that is written in these comments. Stop moaning and start selling what's good about GP!

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  • rcgp and supporters:
    lets sell whats good? there are lots of good things which happens in primary care BUT

    students have significant debt now days: they have a choice: I need to advise them as I would my own children in current state. by now you know the answer !!!!!! if not get a brain function test done

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  • Thanks for your opinion Ivan - but that's unfortunately exactly the plan of successive governments - they have "started selling what's good about GP!"

    The changes that they are making in stop independent contractor status, and selling off APMS contracts, and hiving off contracts to private vulture companies is a major part of the problem.

    As is the selling off of our piece of mind and rest time, with ideas propagated by people like Ivan - where we will all end up working 12 hour days 7 days a week again, and kiss good bye to our family time.

    Also not helped when former 'Spokespersons' for GP are selling the idea of a complete salaried work force - dare I say employed by their own Private companies, so some vested undeclared conflicts of interest out there.

    We also had another of the best bits of GP sold out when the BMA let the sell off off our pensions.

    You're completely right Ivan - we are selling off all the best bits of General Practice.

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  • Fom my point of view "...what's good about GP" sadly is being eliminated by all the outside interference, aided and abetted by political GPs who appear to have their own agenda. I'd be happy to recommend real general practice - not the administration-heavy, pressured, over-scrutinised, morale-sapping, media-denigrated, deprofessionalised version that seems to be seeping in.

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  • Ivan,

    fascism also had good points - rule of law, for instance.
    But it also led to WWII.

    Its actually morally wrong to only make things look better when they are plain rubbish. There are some great points about general practice, but these have all been eroded away and are far outweighed by the negatives. I teach medical students, and I've made it clear to them the positives and negatives of the job.

    I offer a balanced view to my patients, by extension our professionalism should extend to those we teach. Anything else is unprofessional.

    But then Ivan's comments are purposely meant to be inflammatory, so its easier to just ignore him.

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  • Una Coales. Retired NHS GP.

    I tried to get my teen daughters interested in general practice...

    One did 2 summer work experiences at 2 different local NHS GP surgeries. What did it teach her? To pursue a career in banking.

    So I tried with another daughter. This time I sent her to an open day at the Chelsea and Westminster hospital arranged by Imperial for students keen to pursue medicine. Guess what! They discouraged her by saying NHS hospitals were being closed and there wouldn't be enough NHS hospitals for UK medical school graduates to do their training in and some were heading to America to do training. And how competitive it was to apply to Imperial and how many they declined. The prospect of no hospital specialty training job, studying for 5-6 years and ending up with HUGE medical school loans, convinced this other daughter of mine NOT to pursue medicine.

    Well I tried...ho hum.

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  • @Ivan - I am beginning to think the above commentator is right and you deliberately leave inflammatory comments.
    You are completely out of touch with your fellow GPs - the 'drivel' left in these columns reflects the opinions of your colleagues and is an indication of the state of primary care in this country. It us unfair and morally wrong to mislead students/trainees by misrepresenting the truth, and 'talking up' the situation.
    Take off the blinkers and rather than reading and scoffing - actually take in what is written.
    I think you probably quite like the controversy of your comments, possibly the attention so as with 1.05pm - better to ignore you in future

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